Keratoconus-integrated characterization considering anterior corneal aberrations, internal astigmatism, and corneal biomechanics

Alió, Jorge L.; Piñero, David P.; Alesón, Alicia; Teus, Miguel A.; Barraquer, Rafael I.; Murta, Joaquim; Maldonado, Miguel J.; Luna, Gracia Castro de; Gutiérrez, Ramón A.; Villa, César; Uceda-Montañés, Antonio

doi:10.1016/j.jcrs.2010.10.046

Cited by 157 publications

(136 citation statements)

References 55 publications

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“…15 Grade I included patients with spectacle-corrected distance visual acuity (CDVA) (decimal notation) of 0.90 or better; grade II, patients with CDVA equal to or better than 0.60 and worse than 0.90; grade III, patients with CDVA equal to or better than 0.40 and worse than 0.60; grade IV, patients with CDVA equal to or better than 0.20 and worse than 0.40; and grade plus, patients with CDVA worse than 0.20.…”

Section: Methodsmentioning

confidence: 99%

“…18 Nevertheless, most of these grading systems have been developed taking into account the topographic morphology of the disease, the corneal keratometry readings, and corneal aberrometry, without considering other clinical data that are closely related to the visual disability caused by keratoconus. Thus, the success or failure of this surgical technique is analyzed in this study, using a keratoconus classification based on the functional performance of the patient's visual system, 15 such as visual acuity, rather than just the geometric assessment of the cornea, which is unpredictable because of response of keratoconic eyes. [19][20][21] Most of the published studies analyzing the effectiveness of ICRS implantation for the treatment of keratoconus agree that there is a significant flattening of the central cornea after the procedure.…”

Section: In This Study We Evaluated the Outcomes Of Icrsmentioning

confidence: 99%

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Outcome Analysis of Intracorneal Ring Segments for the Treatment of Keratoconus Based on Visual, Refractive, and Aberrometric Impairment

Vega-Estrada

Alió

Brenner

et al. 2013

American Journal of Ophthalmology

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116

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PURPOSE: To analyze the outcomes of intracorneal ring segment (ICRS) implantation for the treatment of keratoconus based on preoperative visual impairment. DESIGN: Multicenter, retrospective, nonrandomized study.METHODS: A total of 611 eyes of 361 keratoconic patients were evaluated. Subjects were classified according to their preoperative corrected distance visual acuity (CDVA) into 5 different groups: grade I, CDVA of 0.90 or better; grade II, CDVA equal to or better than 0.60 and worse than 0.90; grade III, CDVA equal to or better than 0.40 and worse than 0.60; grade IV, CDVA equal to or better than 0.20 and worse than 0.40; and grade plus, CDVA worse than 0.20. Success and failure indices were defined based on visual, refractive, corneal topographic, and aberrometric data and evaluated in each group 6 months after ICRS implantation.RESULTS: Significant improvement after the procedure was observed regarding uncorrected distance visual acuity in all grades (P < .05). CDVA significantly decreased in grade I (P < .01) but significantly increased in all other grades (P < .05). A total of 37.9% of patients with preoperative CDVA 0.6 or better gained 1 or more lines of CDVA, whereas 82.8% of patients with preoperative CDVA 0.4 or worse gained 1 or more lines of CDVA (P < .01). Spherical equivalent and keratometry readings showed a significant reduction in all grades (P £ .02). Corneal higher-order aberrations did not change after the procedure (P ‡ .05).CONCLUSIONS: Based on preoperative visual impairment, ICRS implantation provides significantly better results in patients with a severe form of the disease. K ERATOCONUS IS AN ECTATIC DEBILITATING corneal disorder characterized by a progressive corneal thinning that results in corneal protrusion, irregular astigmatism, and decreased vision. 1 A variety of options have been described for the management of this pathologic condition, such as rigid gas-permeable contact lenses, 2 corneal collagen cross-linking, 3 intracorneal ring segment implantation, 4-11 or keratoplasty. 12 In a number of studies intracorneal ring segments (ICRS) have been demonstrated to be effective in improving visual acuity and reducing the refractive error and the mean keratometry in selected cases of keratoconic eyes. 4-11 Such a positive therapeutic effect is considered to be based on the induction of a remodeling of the corneal anterior and posterior surface's topography, which improves the optical quality of the cornea and reduces the optical aberrations, with consequent improvement in best-corrected visual acuity. [4][5][6][7][8][9][10][11] Although in the healthy cornea, the sectorial arcuate addition to the corneal local volume caused by these implants at the corneal midperiphery induces a flattening of the central cornea in an arc-shortening effect, with the consequence of a decrease in myopic spherical equivalent attributable to the overall reduction in the optical power of the cornea, 13 such corneal modeling effect may be different in structurally abnormal corneas such as in keratoco...

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Section: Methodsmentioning

confidence: 99%

Section: In This Study We Evaluated the Outcomes Of Icrsmentioning

confidence: 99%

Outcome Analysis of Intracorneal Ring Segments for the Treatment of Keratoconus Based on Visual, Refractive, and Aberrometric Impairment

Vega-Estrada

Alió

Brenner

et al. 2013

American Journal of Ophthalmology

Self Cite

116

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“…[2][3][4][5][6]17,67,68 Higher amounts of vertical coma and larger values of coma-like root mean square (RMS) have been reported in patients with keratoconus or keratoconus suspect. [2][3][4][5][6]17,67 In 2006, the first keratoconus severity grading system that used the magnitude of anterior corneal coma-like aberrations as the main classifying criterion was developed (Table 3). 4 In 23 eyes with keratoconus, 10 eyes with subclinical keratoconus (keratoconus suspect by definition), and 127 controls, B€ uhren et al 17 evaluated the keratoconus detection ability of anterior corneal Figure 3.…”

Section: Corneal Aberrometric Analysis In Keratoconusmentioning

confidence: 99%

“…73 Significant differences in central and minimum corneal thickness have been shown between subclinical, early, moderate, and advanced keratoconus, 67,74 which is useful to characterize the severity of keratoconus. The advances in imaging technology allow the clinician to obtain pachymetric maps providing point-by-point information of the entire cornea ( Figure 5).…”

Section: Pachymetric Analysis In Keratoconusmentioning

confidence: 99%

“…The combination of several clinical tests is extremely useful for detection and complete characterization of keratoconus. 67 It should be mentioned that anamnesis is crucial because some antecedents, such as the diagnosis of corneal ectasia in other members of the family, can alert the clinician. Some studies reveal the presence of topographic patterns compatible with keratoconus in family members of patients diagnosed with keratoconus, as well as in the fellow eyes of patients in whom keratoconus has been clinically diagnosed.…”

Section: Integral Analysis Of Corneal Structurementioning

confidence: 99%

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Characterization of corneal structure in keratoconus

Piñero¹,

Nieto²,

López-Miguel³

2012

Journal of Cataract and Refractive Surgery

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142

113

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Corneal Morphologic Characteristics in Patients With Down Syndrome

et al. 2018

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IMPORTANCE Literature suggests corneal morphologic characteristics compatible with keratoconus are present in a high percentage of patients with Down syndrome (DS), suggesting the need to perform a detailed examination of the anterior segment to try to avoid serious visual impairment in this group of patients. OBJECTIVE To characterize the abnormal features of the cornea in patients with DS and compare these with a control group. DESIGN, SETTING, AND PARTICIPANTSMulticenter case-control study at Vissum Alicante, . The study included 321 eyes of 217 participants from 2 groups: 112 participants in the DS group and 105 healthy participants in the control group.INTERVENTIONS Patients were evaluated using Placido disc/Scheimpflug camera topographer (Sirius, CSO). Visual, refractive and anterior, and posterior corneal characteristics were assessed and compared in both groups.MAIN OUTCOMES AND MEASURES Keratoconus diagnosis. Incidence of corneal morphologic irregularities similar to keratoconus in patients with DS. RESULTSIn the DS group, mean (SD) age was 14.88 (15.76) years, 54 (48%) were women, 66 (59%) were white, and 46 (41%) were Arab. In the control group, mean (SD) age was 40.29 (14.66) years, 54 (51%) were women, and all were white. Clinical assessment of corneal topography showed that 71.3% (95% CI, 45.2-97.4) of patients in the DS group showed characteristics compatible with keratoconus. Differences were found in steepest keratometry of 47.35 diopters (D) in patients with DS vs 43.70 D in control individuals (difference, 3.65 D; 95% CI, 3.23-4.35 D; P <.001) and in corneal pachymetry of 503 μm in patients with DS vs 545 μm in control individuals (difference, 42 μm; 95% CI, 38.8-56.7 μm; P <.001).CONCLUSIONS AND RELEVANCE Patients with DS have steeper and thinner corneas and more corneal aberrations than those without genetic alterations and normal corneas. The findings suggest a detailed corneal study should be considered in such patients to detect keratoconus and implement treatment as appropriate to try to avoid serious visual impairment in this group of patients. JAMA Ophthalmol. 2018;136(9):971-978.

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Keratoconus-integrated characterization considering anterior corneal aberrations, internal astigmatism, and corneal biomechanics

Abstract: The visual limitation in keratoconus could be explained by different alterations that occur in these corneas and allowed development of a new grading system for this condition.

Cited by 157 publications

References 55 publications

Outcome Analysis of Intracorneal Ring Segments for the Treatment of Keratoconus Based on Visual, Refractive, and Aberrometric Impairment

Outcome Analysis of Intracorneal Ring Segments for the Treatment of Keratoconus Based on Visual, Refractive, and Aberrometric Impairment

Characterization of corneal structure in keratoconus

Corneal Morphologic Characteristics in Patients With Down Syndrome

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